Gall stone dissolution with methyl tert-butyl ether: how to avoid complications

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Endourology

Background:

• Gall bladder stones (cholelithiasis) are a common condition requiring effective treatment.
• Dissolving gall stones offers a less invasive alternative to surgical cholecystectomy.
• Methyl tert-butyl ether (MTBE) has been explored for its litholytic properties.

Purpose of the Study:

• To evaluate the efficacy and safety of methyl tert-butyl ether for dissolving cholesterol gall bladder stones.
• To assess the complication rates associated with MTBE treatment.
• To report on improvements in technique and management of adverse events.

Main Methods:

• Fifty of 52 patients with cholesterol gall stones underwent MTBE treatment.
• Treatment involved dissolution of stones over an average of 9.5 hours.
• Techniques were refined, including improved puncture sets, stone extraction baskets, tissue adhesives, and ceruletid administration to minimize complications.

Main Results:

• 96% of patients (48/50) experienced complete dissolution of gall stones.
• Mean stone size was 1.7 cm and mean stone number was 14.6.
• Complications included nausea, vomiting (24%), bile leakage, and haematobilia (4%), with 44 patients treated without complications after technique modifications.

Conclusions:

• Methyl tert-butyl ether is a successful treatment for cholesterol gall bladder stones with a high dissolution rate.
• Improved techniques and management strategies significantly reduced complication rates.
• MTBE dissolution offers a safe and effective option for selected patients with gall bladder stones.